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Medication has now been added to a list of proven or postulated causes of CRS-related fatigue: systemic response to local inflammation, sleep disturbance, upper airway resistance syndrome, psychological distress, and reflex response to nasal irritation. Unfortunately, we could not rule out the upper airway resistance syndrome as we could not measure intrathoracic pressure. Chronic sleep deprivation and upper airway resistance syndrome must be aggressively ruled out because idiopathic hypersomnia is a diagnosis of exclusion, and the results of formal sleep studies, discussed below, are normal. |
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